Provider Demographics
NPI:1306462791
Name:LACY, JULIE H
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:H
Last Name:LACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38610 N 3986 DR
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:OK
Mailing Address - Zip Code:74061-2577
Mailing Address - Country:US
Mailing Address - Phone:918-332-0770
Mailing Address - Fax:
Practice Address - Street 1:38610 N 3986 DR
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:OK
Practice Address - Zip Code:74061-2577
Practice Address - Country:US
Practice Address - Phone:918-332-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator